One of the interesting things about being a small-animal veterinarian is the variety of tasks we perform. We jump from general practice for wellness exams and vaccines, to internal medicine for ill patients, to dentistry, and to surgery – often all in the same morning. In speaking with clients, I notice that many questions tend to focus on pet surgery: what’s it like? How do you do it? Is it fun, scary, or both?
A surgical procedure at North Hills follows many steps. The first step, which usually takes place before the surgery date, is to discuss the procedure with the client. We talk about the underlying problem, the manner in which surgery may help, post-operative care, and the relative risks and rewards of the procedure. We also prepare an estimate of the costs, which we are happy to discuss with our clients if they have questions.
As many of you know, we ask that you withhold food from the patient on the morning of the procedure. A stomach full of food increases the risk of vomiting, which is one thing we’d prefer to avoid during or after surgery. The patient arrives at North Hills bright and early in the morning, no doubt wondering why no breakfast was served. We examine the patient (we do this even if we had examined the day before surgery) and make sure that heart sounds, breathing, pulse quality, and overall condition are conducive for surgery.
We also usually run blood work to make sure that the patient’s blood counts, electrolyte levels, kidney function and liver function are acceptable for surgery. I say “usually”, because we may not need to repeat blood work if it had been run recently and everything looked fine.
Once the surgeon examines the patient, evaluates blood work and gives the OK to proceed, the patient is given a pre-anesthetic medication that serves to relax the patient and provide some early pain relief. One of our skilled veterinary technicians will then place an intravenous catheter, usually in a front leg. An intravenous catheter serves many functions: it allows us to give medications through the catheter; fluid administration through the catheter helps with hydration as well as blood pressure maintenance; and it provides ready access to a vein in the highly unlikely, but always possible, event that we need to provide emergency assistance to a patient during anesthesia.
The next step is to anesthetize our patient. An intravenous medication is given through the catheter that provides immediate, albeit short term, anesthesia. We then intubate the patient, and use a combination of oxygen and a gas anesthetic to keep the patient under a comfortable plane of anesthesia. Anesthetized patients are monitored in many ways. In addition to the doctor and technician paying strict attention at all times to the patient, we monitor heart rate; oxygenation of blood; pulse; ECG; and blood pressure. We always keep emergency medications and equipment close at hand, and we calculate doses for such medicines prior to surgery.
Then comes the interesting part: the operation! Putting scalpel to skin is daunting at first, but one gets used to it after a while. You’d be surprised at how little an incision into skin bleeds – at least if it is done with a scalpel. Other tissues bleed much more readily. If the sight or smell of blood makes you squeamish, don’t pursue a career in surgery!
People may be surprised at how much movement can occur among abdominal organs. Intestines and spleen in particular can move around quite a bit. People may also be surprised at how visible and tangible many illnesses are. Terms like cancer, pancreatitis or inflammatory bowel disease may seem like ethereal concepts, but in reality they are quite physical and, often, readily apparent.
One of the most time-consuming parts of any surgical procedure involves suturing. If a dog has a large mass under its skin, for example, I can usually remove it in 10 minutes or less. Closure of the incision, however, can take much longer. Proper suture technique involves an approach that allows for both a cosmetic and permanent closure – not always easy to accomplish.
A vital component of any surgical procedure is the post-operative recovery of the patient. We frequently discuss the need to maintain a certain amount of “post-op paranoia” in order to prevent even the slightest lapse in patient monitoring during the recovery phase. It is critical that vet technicians and doctors monitor the patient until it is extubated, conscious, breathing on its own and sitting up in the recovery area.
The last aspect of any surgical procedure involves discussing the outcome and findings with the owner, as well as transcribing our surgical record. If the patient is going home with medication, we will get those ready as well as a summary of discharge instructions.
So, what is it like to perform surgery? It can be daunting the first few times, but one quickly becomes accustomed to it. Surgery also provides a satisfying closure (literal and figurative) that medical cases often do not. With surgery, it either works or it doesn’t.
As with most things, surgical success requires proper preparation beforehand. If the surgeon and staff are well-versed in a procedure, the procedure should be almost routine. I say almost, because pet surgery reminds me of what pilots say about flying: 99% boring, 1% exciting. At North Hills Animal Hospital & Resort, we strive to keep our surgical procedures as boring as possible.